Pancho - CAM-HER-65

Code: CAM-HER-65
Mercy ID: V-00067-02
Encounter Date: 01/25/2000
Last: Campos
First: Herberth
DOB: 09/10/1965
County: Dekalb
Street: 3061 Oakcliff Rd. Apt. 22
City: Doraville
State: GA

Zip

30340-

Home

(770) 457-6994

Family Status

Two parent family w/children

COB

Guatemala

Gender

Male

Housing

Not Homeless

Education Level

High school graduate

Home Owner

YES

Parents Information

	Name	DOB	COB
Mother	N/A	N/A	N/A
Father	N/A	N/A	N/A
Step Parent	N/A	N/A	N/A

Driver: No
Relative: No
Stranger: No
Lives With: N/A
Name of School: N/A
Grade: N/A
Who Can't Pickup the Child
Authoritation Parent: No
Authoritation Child: No
DOY PERMISO: No
Limitado Educativo: No
Limitado Impresos: No
Limitado Caminar Latino: No

Intake: F. Perez
Data Entry: Y. Garcia